| NPI | 1851931984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 040863) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007520) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2025-02-07 |